The Honorable William
Jefferson Clinton
President of the United States
The White House
1600 Pennsylvania Avenue
Washington, D.C. 20500

Dear Mr. President:

Over the past several
years, the cancer community has been engaged in extensive dialogue with
the Administration and the Congress about appropriate levels of payment
for anti-cancer drugs, both in physician offices and in hospital outpatient
departments. We believe we have made a convincing caselargely accepted
by both the Administration and the Congressthat radical cuts in
Medicare payment for these drugs cannot be undertaken without seriously
compromising the quality of cancer care. Indeed, a proposal to reduce
drug payments by essentially redefining the benchmark reimbursement concept
of average wholesale price (AWP) was withdrawn by the Health Care Financing
Administration (HCFA), and Congress is in the process of defining an evidence-based pathway toward reform of drug payments, particularly in physician offices.

Given these encouraging
developments, we were quite surprised and distressed to learn that HCFA
has embarked on yet another assault on payment for life-extending anti-cancer
drugs, this time in the hospital outpatient department. HCFA officials
have notified various organizations in the cancer community and beyond
that they plan to reduce payment for anti-cancer drugs in the hospital
outpatient setting, based on a statutory adjustment provision in the 1999
Balanced Budget Refinement Act. We strongly oppose this HCFA initiative
for the following reasons:

(1) If, as HCFA plans,
payment for anti-cancer drugs is reduced 50%, there will be overwhelming
financial pressure for hospitals to cease providing outpatient cancer
chemotherapy. Although this result would be devastating to cancer patients
across the country, we believe it might particularly affect low-income
and minority patients in inner cities, who are more likely to access cancer
care through hospitals rather than private physician offices. As with
earlier proposed cuts, we would make the point that, once this vital infrastructure is destroyed, it will be very difficult to reconstruct.

(2) This action by
HCFA is not mandated by statute but is instead within the discretion of
HCFA and the Department of Health and Human Services (HHS). Indeed, in
the final rule implementing the 1999 legislation, HCFA indicated it would
not make adjustments of the sort it now is pursuing. We believe we deserve an explanation as to why the Administration would exercise its discretion in a manner that cannot help but undercut quality cancer care.

(3) In light of the
position taken by HCFA in the final rule, it is difficult to see how HCFA
could undertake an adjustment of this magnitude without once again going
through a notice-and-comment rulemaking process. Absent such a process,
the HCFA initiative would violate the Administrative Procedure Act.

Mr. President, we
know you care about people with cancer and are certain that you would
not want your Administration to do anything to compromise the quality
of cancer care in this country. Nevertheless, a series of HCFA initiatives,
including this most recent one, has caused many to question the compatibility
of HCFA policies with quality cancer care. We urge your involvement in
this issue to encourage HCFA and HHS to exercise their discretion in a
way that supports the legitimate needs of cancer patients.